Accu-Chek Combo

Sun 18 October 2009

The Accu-Chek Combo is an insulin pump that has the potential to make really important changes to how I manage my
diabetes and therefore my live. It'll allow me to change how much insulin I get when and so better match my body's
needs.

Let's do the downsides first:

It's a machine that I have to wear - always

There are a lot of "fiddley" components and parts

Configuring it to me is going to take a lot of time

There are going to be some upsides too of course:

I can up the background rates by adjusting the insulin rate on an hour-by-hour basis

The combined meter/advisor is a major improvement over previous devices

I can record and analyse things like basal rates, insulin sensitivity, onset and durations

I got it last Friday (2009-10-16), and on that morning we'd (there were 4 of us receiving their Combos) helped each
other programme our units. I was going to be on a 0.68 U/hr flat profile - though by the end of the day I'd made a
small change to start counter-acting the severe case of dawn phenomenon that I suffer from.

Then there were a few details that happened on that first day:

Went low by 4am (3.9) - therefore I want to have 1 U less between midnight and 4 am.

Also, +0.2 is not enough to deal with the Dawn Phenomenon => up from 4 to 6 am by another +1U

Then smoothened out a little, I got this:

This chart shows a marked reduction between midnight (on the left) and three am, and a major increase between 3 and 6
am - to start countering the dawn phenomenon.

As an aside - that low-to-high swing from midnight to 6 am is simply not doable with insulin which is injected in the
more "normal" or usual fashion. Different profiles are indeed possible, and for most diabetics they do cover their
needs -but I don't fit into that category. This is why the Combo pump is so important for my control.

So - how did this work out?

Well - no hypo overnight so the first part was good. As it happened, my bedtime glucose was only 4.9 (below the DAFNE
recommended 6.5 so I took an additional 10g carbs - so noy hypo-ing in that circumstance was really quite good.

And the second part was at least a partial success. For the first time in 6 months I had a proper lie-in - I didn't
waken 'til 10 - which for me would have GUARANTEED me a glucose level of 17 or more - but this morning it was only
11.0. OK - so not perfect, and as the 1.8U given then wasn't enough to stop my glucose from rising to 12.2 by 11:37
I can see that I still need another 2U to be delivered before 9 (as it seems my sensitivity is at 3mmol/l per 1U) -
but perhaps I'll take it a little more slowly than that at first!